QS203 - Thirty-Day Hospital Readmission After Redo Ileal Pouch-Anal Anastomosis And/Or Pouch Revision

Purpose/Background: Redo IPAA is defined as an operation for pouch failure with disconnection of ileal pouch anal anastomosis and reanastomosis. This may be performed by utilizing the existing pouch or creation of a new pouch. Pouch revision entails repair or modification of the existing pouch. Some patients may require pouch revision and redo IPAA simultaneously. The rates of 30-day hospital readmission following redo IPAA surgery and/or pouch revision remain poorly defined. Our aim is to determine 30-day hospital readmission rates following redo IPAA and/or pouch revision at a quaternary referral IBD center.

Methods/Interventions: A retrospective review of a prospectively maintained pouch database of patients who underwent reoperative surgery following ileal pouch-anal anastomosis (IPAA) from December 2016 to August 2023 at a referral IBD center was performed. Data regarding demographics, hospitalization, operative reports and readmission were collected. Univariate and multivariate analyses were performed to evaluate factors associated with readmission.

Results/Outcomes: 239 patients underwent reoperative surgery during the study period. The median age at surgery was 42 years (IQR: 31-52) and 136 patients were female (56.9%). 186 patients underwent redo IPAA without pouch revision (77.8%), 45 patients underwent redo IPAA with pouch revision (18.8%) and 8 patients underwent pouch revision alone (3.3%). In patients undergoing redo IPAA, 143 patients required creation of a new pouch (76.8%). 30-day primary readmission rate was 16.3% (n= 39) and of these, 4 patients had two readmissions within the 30-day period (1.7%). The most common indications for readmission were: Acute Kidney Injury (AKI) or dehydration in 12 patients (27%), pelvic sepsis in 10 patients (23.2%), surgical site infections in 7 patients (16.3%) and ileus/ partial small bowel obstruction in 5 patients (11.6%). Two patients required reoperation for surgical site infections and two patients for pelvic sepsis. Five patients required procedures with interventional radiology for pelvic sepsis. Among patients who underwent redo IPAA surgery, patients with 30-day admission were significantly more likely to have had a new pouch created compared to utilization of the existing pouch (22.4 vs 6.8, p< 0.01).

Conclusion/Discussion: In our quaternary referral center, redo IPAA and/or pouch revision has a readmission rate of 16.3%. Creation of a new pouch is associated with a significantly higher risk of readmission compared to utilization of the de novo pouch. This may be attributed to case complexity that warrants creation of a new pouch as well as a higher incidence of dehydration due to a more proximal diverting ileostomy. The study highlights the occurrence of high readmission rates in the setting of redo IPAA/ revisional pouch surgery and can serve as a crucial tool in informed decision making by patients and providers.